@article {759, title = {Lp(a) lipoprotein, vascular disease, and mortality in the elderly.}, journal = {N Engl J Med}, volume = {349}, year = {2003}, month = {2003 Nov 27}, pages = {2108-15}, abstract = {

BACKGROUND: As compared with what is known about predictors of vascular events in middle-aged persons, less is known about these events in the elderly. Lp(a) lipoprotein, which plays an important part in atherothrombogenesis, has been associated with an increased risk of vascular disease. We investigated this relation among older U.S. adults.

METHODS: In a prospective study of 5888 community-dwelling older adults (65 years of age or older) in the United States, 2375 women and 1597 men who were free of vascular disease provided base-line serum samples for analysis for levels of Lp(a) lipoprotein. These 3972 subjects were followed for a median of 7.4 years to evaluate the development of stroke and to track deaths from vascular causes and all causes. The men and women were divided into quintile groups according to the Lp(a) lipoprotein level at base line.

RESULTS: Using Cox proportional-hazards models, we determined the risk associated with each quintile level of Lp(a) lipoprotein, with the lowest quintile serving as the reference group. As compared with those in the lowest quintile, men in the highest quintile had three times the unadjusted risk of stroke (relative risk, 3.00; 95 percent confidence interval, 1.59 to 5.65), almost three times the risk of death associated with vascular events (relative risk, 2.54; 95 percent confidence interval, 1.59 to 4.08), and nearly twice the risk of death from all causes (relative risk, 1.76; 95 percent confidence interval, 1.31 to 2.36). Adjustment for age; sex; the levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides; carotid-wall thickness; smoking status; the presence or absence of diabetes and systolic and diastolic hypertension; body-mass index; and other traditional risk factors had little effect on the final assessments. Similar analyses for women, which also included adjustment for estrogen use or nonuse, revealed no such relation.

CONCLUSIONS: Among older adults in the United States, an elevated level of Lp(a) lipoprotein is an independent predictor of stroke, death from vascular disease, and death from any cause in men but not in women. These data support the use of Lp(a) lipoprotein levels in predicting the risk of these events in older men.

}, keywords = {Aged, Coronary Disease, Female, Humans, Incidence, Lipoprotein(a), Male, Mortality, Proportional Hazards Models, Prospective Studies, Risk Factors, Sex Factors, Stroke, Survival Analysis, United States, Vascular Diseases}, issn = {1533-4406}, doi = {10.1056/NEJMoa001066}, author = {Ariyo, Abraham A and Thach, Chau and Tracy, Russell} } @article {992, title = {Depressive symptoms, inflammation, and ischemic stroke in older adults: a prospective analysis in the cardiovascular health study.}, journal = {J Am Geriatr Soc}, volume = {55}, year = {2007}, month = {2007 Nov}, pages = {1825-30}, abstract = {

OBJECTIVES: To investigate the mediator role of inflammation in any relationship between depressive symptoms and ischemic stroke.

DESIGN: Longitudinal prospective study.

SETTING: Review of medical records, death certificates, and the Medicare healthcare utilization database for hospitalizations.

PARTICIPANTS: Total of 5,525 elderly men and women aged 65 and older who were prospectively followed from 1989 to 2000 as participants in the Cardiovascular Health Study.

MEASUREMENTS: Depression symptom scores, inflammatory markers.

RESULTS: Greater depressive symptoms were associated with risk of ischemic stroke (unadjusted hazard ratio (HR)=1.32, 95\% confidence interval (CI)=1.09-1.59; HR=1.26, 95\% CI=1.03-1.54, adjusted for traditional risk factors). When a term for inflammation (C-reactive protein (CRP)) was introduced in the model, the HRs were not appreciably altered (unadjusted HR=1.31, 95\% CI=1.08-1.58; adjusted HR=1.25, 95\% CI=1.02-1.53), indicating that CRP at baseline was not a mediator in this relationship. In analyses stratified according to CRP levels, a J-shaped relationship between depressive symptoms and stroke was evident in the unadjusted analyses; in the fully adjusted model, only CRP in the highest tertile was associated with a higher risk for stroke in the presence of higher depressive symptoms scores.

CONCLUSION: The analyses from this prospective study provide evidence of a positive association between depressive symptoms and risk of incident stroke. Inflammation, as measured according to CRP at baseline, did not appear to mediate the relationship between depressive symptoms and stroke.

}, keywords = {Aged, C-Reactive Protein, Cardiovascular Diseases, Cerebral Infarction, Cohort Studies, Depression, Female, Geriatric Assessment, Humans, Inflammation, Kaplan-Meier Estimate, Longitudinal Studies, Male, Multivariate Analysis, Personality Assessment, Proportional Hazards Models, Prospective Studies, Psychoneuroimmunology, Risk Factors, Socioeconomic Factors, Statistics as Topic, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2007.01393.x}, author = {Arbelaez, Jose J and Ariyo, Abraham A and Crum, Rosa M and Fried, Linda P and Ford, Daniel E} }